| NPI | 1922483296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L8045) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 0858761) |
| 104100000X Social Worker | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2020-02-04 |